Abstract
Major advances have been made in the cognitive understanding and treatment of the symptoms of schizophrenia, including delusions, hallucinations, and emotional withdrawal. Experimental studies on the psychologic aspects of schizophrenia demonstrate the importance of information processing biases, such as cognitive biases and distortions, that are functionally related to the maintenance of symptoms. Understanding the aspects of schizophrenia in cognitive terms provides a framework for psychotherapeutic intervention with the adaptation of the cognitive strategies proven effective in the treatment of mood and anxiety disorders. The authors of this paper first outline the cognitive conceptualization and strategies employed by cognitive therapists to treat positive and negative symptoms, and conclude with a summary of the empiric status of cognitive therapy for schizophrenia. Cognitive therapy has been shown to be an important adjunct to standard treatments of schizophrenia.
Similar content being viewed by others
References and Recommended Reading
Beck AT: Successful outpatient psychotherapy with a schizophrenic with a delusion based on borrowed guilt. Psychiatry 1952, 15:305–312.
Hole RW, Rush AJ, Beck AT: A cognitive investigation of schizophrenic delusions. Psychiatry 1979, 42:312–319.
Watts FN, Powell GE, Austin SV: The modification of abnormal beliefs. Br J Med Psychol 1973, 46:359–363.
Chadwick PDJ, Lowe CF: A cognitive approach to measuring and modifying delusions. Behav Res Ther 1994, 32:355–367.
Slade PD, Bentall RP: Sensory Deception: A Scientific Analysis of Hallucinations. London: Croom Helm; 1988.
Haddock G, Slade PD, Bentall RP, et al.: A comparison of the long-term effectiveness of distraction and focusing in the treatment of auditory hallucinations. Br J Med Psychol 1998, 71:339–349.
Wykes T, Parr A, Landau S: Group treatment of auditory hallucinations. Brit J Psychiatry 1999, 175:180–185.
Bouchard S, Vallieres A, Roy MA, Maziade M: Cognitive restructuring in the treatment of psychotic symptoms in schizophrenia: a critical analysis. Behav Therapy 1996, 27:257–278.
Beck AT, Rector NA: Delusions: a cognitive perspective. J Cog Psychol 2002, In press. Presents a phenomenologic description of the characteristics of delusions and their development from a cognitive perspective.
Bentall RP, Kinderman P, Kaney S: Self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Beh Res Ther 1994, 32:331–341.
Kaney S, Bentall RP: Persecutory delusions and attributional style. Br J Med Psychol 1989, 62:191–198.
Bentall RP, Kaney S, Dewey ME: Paranoia and social reasoning: an attribution theory analysis. Br J Clin Psychol 1991, 30:13–23.
Garety PA, Hemsley DR, Wessely S: Reasoning in deluded schizophrenic and paranoid patients: biases in performance on a probabilistic inference task. J Nerv Ment Dis 1991, 179:194–202.
Fear CF, Healy D: Probabilistic reasoning in obsessivecompulsive and delusional disorders. Psychol Med 1997, 27:199–208.
Peters E, Day S, Garety P: From preconscious to conscious processing: where does the abnormality lie in delusions? Schizophr Res 1997, 24:120.
Young JF, Bentall RP: Social reasoning in individuals persecutory delusions: the effects of additional information on attributions for the observed behavior of other. Br J Clin Psychol 1997, 36:569–573.
Dudley REJ, John CH, Young AW, Over DE: Normal and abnormal reasoning and people with delusions. Br J Clin Psychol 1997, 36:243–258.
Young HF, Bentall RP, Slade PD, Dewey ME: The role of brief instructions and suggestibility in the elicitation of hallucinations in normal and psychiatric subjects. J Nerv Ment Dis 1987, 175:41–48.
Morrison AP, Haddock G: Cognitive factors in source monitoring and auditory hallucinations. Psychol Med 1997, 27:669–679.
Birchwood M, Chadwick PDJ: The omnipotence of voices: testing the validity of a cognitive model. Psychol Med 1997, 27:1345–1353.
Chadwick PD, Birchwood MJ: Challenging the omnipotence of voices: a cognitive approach to auditory hallucinations. Br J Psychiatry 1994, 164:190–201.
Beck AT, Rector NA: A cognitive analysis of hallucinations. Journal 2002, In press.
Berenbaum H, Oltmanns TF: Emotional experience and expression in schizophrenia and depression. J Abnorm Psychol 1992, 101:37–44.
Kring AM, Neale JM: Do schizophrenic patients show a disjunction among expressive, experiential, and psychophysiological components of emotion? J Abnorm Psychol 1996, 105:249–257.
Earnst KS, Kring AM: Emotional responding in deficit and non-deficit schizophrenia. Psychiatry Res 1999, 88:191–207.
Alpert M, Clark A, Pouget ER: The syntactic role of pauses in the speech of schizophrenic patients with alogia. J Abnorm Psychol 1994, 103:750–757.
Siris SG: Depression in Schizophrenia. Washington, DC: American Psychiatric Press; 1995.
Siris SG, Adan F, Cohen M, et al.: Post-psychotic depression and negative symptoms: an investigation of syndromal overlap. Am J Psychiatry 1988, 145:1532–1537.
Beck AT, Rush AJ, Shaw BF, Emery G: Cognitive Therapy of Depression. New York, Guilford Press, 1979.
Rector NA, Beck AT: Cognitive behavioral therapy for schizophrenia: an empirical review. J Nerv Ment Dis 2001, 189:278–287. Provides a quantitative review of the randomized controlled trial studies published that have examined the efficacy of cognitive therapy for schizophrenia. The discussion focuses on the empiric status of cognitive therapy for schizophrenia, limitations in the research published thus far, and outlines questions for future investigation.
Kuipers E, Garety P, Fowler D, et al.: London-East Anglia randomized controlled trial of cognitive-behavioral therapy for psychosis, I. Effects of the treatment phase. Br J Psychiatry 1997, 171:319–327.
Tarrier N, Beckett R, Harwood S, et al.: A trial of two cognitivebehavioral methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. Br J Psychiatry 1993, 162:524–532.
Tarrier N, Yusupoff L, Kinney C, et al.: Randomized controlled trial of intensive cognitive behavior therapy for patients with chronic schizophrenia. BMJ 1998, 317:303–307.
Sensky T, Turkington D, Kingdon D, et al.: A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Arch Gen Psychiatry 2000, 57:165–172.
Pinto A, La Pia S, Mannella R, et al.: Cognitive-behavioral therapy and clozapine for clients with treatment-refractory schizophrenia. Psychiatr Serv 1999, 50:901–904.
Drury V, Birchwood M, Cochrane R, MacMillan F: Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. Br J Psychiatry 1996, 169:593–601.
Drury V, Birchwood M, Cochrane R, MacMillan F: Cognitive therapy and recovery from acute psychosis: a controlled trial. II. Impact on recovery time. Br J Psychiatry 1996, 169:602–607.
Cohen J: Statistical Power Analysis for the Behavioral Sciences. Erlbaum: Hillsdale; 1988.
Kissling W: Ideal and reality of neuroleptic relapse prevention. Br J Psychiatry 1992, 161:133–139.
Corrigan PW, Liberman RP, Engel JD: From noncompliance to collaboration in the treatment of schizophrenia. Hosp Community Psychiatry 1990, 41:1203–1211.
Kemp R, Hayward P, Applewhaite G, et al.: Compliance therapy in psychotic patients: randomized controlled trial. Brit Med J 1996, 312:345–349.
Kemp R, Kirov G, Everitt B, et al.: Randomized controlled trial of compliance therapy: 18-month follow-up. Br J Psychiatry 1998, 172:413–419.
Kent S, Yellowlees P: Psychiatric and social reasons for frequent rehospitalization. Hosp Community Psychiatr 1994, 45:347–350.
Turkington D, Kingdon D, Turner T: The insight program: effectiveness of a brief cognitive-behavioral intervention in the treatment of schizophrenia. Br J Psychiatry 2002, In press.
McGlashan TH: Psychosis treatment prior to psychosis onset: ethical issues. Schizophr Res 2001, 51:47–54.
Miller TJ, McGlashan TH: Early identification and intervention in psychotic illness. Am J Psychiatry 2000, 157:1041–1050.
Schaffner KF, McGorry PD: Preventing severe mental illnesse new prospects and ethical challenges. Schizophr Res 2001, 51:3–15.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Rector, N.A., Beck, A.T. A clinical review of cognitive therapy for schizophrenia. Curr Psychiatry Rep 4, 284–292 (2002). https://doi.org/10.1007/s11920-996-0048-5
Issue Date:
DOI: https://doi.org/10.1007/s11920-996-0048-5